Intro

Everyone participating in NUMA Speed, MUST have a WAIVER on file, if under 18 yrs of age the parent / guardian is required to fill it out and sign for them. If a WAIVER is not completed and on file, you CAN NOT participate.

Agree and Acknowledge

I understand and acknowledge that if I proceed to register online and to sign the waiver electronically, that, under the Electronic Transactions Act, such electronic registration and electronically signed Waiver document will be valid and enforced in the same manner as a hand-signed document that exists in physical form and that a record or signature may not be denied legal effect or enforceability under law solely because it is in electronic form.

Basic Information

Use parent or guardian information if under 18

Contact Information

Use parent or guardian information if under 18

Minor Information

Enter the information for the children for which you are responsible for:



Waiver and Informed Consent Statement :

In consideration for myself or my child’s participation in the activities of NUMA-Speed LLC, I agree to allow video and images taken at any time to be used in any NUMA-Speed LLC. marketing materials, including but not limited to social media, websites and print materials. I also hereby affirm myself/my child is medically able to participate in the activities offered by NUMA-Speed LLC.. I understand that there are risks associated with my child’s participation in the activities of NUMA-Speed LLC. that may include, but are not limited to, the following: mild, moderate, or severe physical and/or mental injuries, or death involved. I agree that myself/my child will follow all instructions related to equipment, exercises, safety rules and physical demands related to the activities. I knowingly consent for myself and / or to my child’s participation in NUMA-Speed activities, and I agree to hold NUMA-Speed LLC. harmless, covenant not to sue and waive any and all liability of NUMA-Speed LLC., its respective officers, employees, members, volunteers, agents and sponsors, and do hereby waive and release and forever discharge any and all rights and claims for damages which I may have or which may accrue to me arising out of or related to my child’s participation in any of the NUMA-Speed LLC. activities, for myself, my heirs, executors and administrators. I acknowledge the particular hazards and potential dangers involved in allowing my child’s participation in the NUMA-Speed LLC. activities. I further give my permission for NUMA-Speed LLC. to seek necessary medical attention for myself/my child/children in the case of an emergency.

I/myself – being the client or my child/children as the client

Signature

By entering my name below and clicking the “Submit Waiver” button below, I indicate my acceptance and delivery of this waiver and release. I acknowledge that I have been given an opportunity to prevent or correct any error in connection with this waiver form. If I have submitted this waiver form in error, I will immediately notify you of the error, revoke my signature as instructed, and refrain from participating in any event or activity to which the waiver applies, as provided in Section 204(b) of the Uniform Electronic Transactions Act.